Women Experiencing Partner Violence More Motivated to Receive PrEP

Women were more likely to be motivated to take pre-exposure prophylaxis (PrEP) after intimate partner violence (IPV) if they had higher symptoms of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), according to a study published in AIDS and Behavior.¹ This finding emphasizes the need to perform both MDD and PTSD screening prior to starting PrEP services.

IPV is estimated to affect 41% of women living in the US,² which can include any act of abuse, aggression, or coercion in a romantic relationship. Physical and mental health outcomes can be affected by any form of IPV. The specific effects of PTSD and MDD on the motivation to use PrEP is not known, although IPV is associated with psychopathologies and the acquisition of HIV. This study aimed to assess the relationship between mental health symptoms and the motivation to use PrEP as well as to identify any latent mental health symptom profiles.

All participants were recruited from the Her PrEP, Her Way (HPHW) study, based in New Haven, Connecticut, and the BMore HPHW study based in Baltimore, Maryland. Participants were eligible for the HPHW study if they were women aged 18 to 35 years, able to speak and comprehend either Spanish or English, lived in Connecticut, and had engaged in a sexual risk indicator for PrEP. Participants were eligible for the BMore HPHW study if they were a woman aged 18 to 35 years, were able to speak and comprehend either English or Spanish, engaged in condom-less sex within the previous year, and had endorsed IPV in the past year. Data were collected from August 2017 to April 2018 in the HPHW study and from February 2018 to July 2019 in the BMore HPHW study.

Women who experienced intimate partner violence along with PTSD and depressive symptoms were more likely to be open to PrEP compared with other women | Image credit: vectorfusionart - stock.adobe.com

PTSD was measured using the PTSD Checklist for DSM-5 (PCL-5), where patients self-reported their symptoms of post-traumatic stress throughout the previous month with a rating system of 0 to 80, with a higher score indicating PTSD. MDD was measured through the Center for Epidemiologic Studies-Depression, which measured MDD on a scale of 0 to 60, with higher scores indicating MDD. The PrEP motivational cascade was used to measure PrEP motivation. This was separated into 4 stages: precontemplation, PrEP contemplation, PrEParation, and PrEP action and initiation. All participants self-reported sociodemographic characteristics.

There were 285 participants: 199 from Connecticut and 86 from Maryland. The mean (SD) age of the participants was 30.6 (10.7) years. A total of 38.9% of the participants identified as White, 38.2% as Black, 13% as Asian, 13.9% as multiracial, and 2% as American Indian/Alaska Native. There were 80.4% of women who were currently in a relationship, and 78.6% of them had been tested for HIV in the past.

A total of 217 of the women were in stage 1 of the PrEP motivational cascade, with 68 woemn in stage 2, 65 in stage 3, and 5 in stage 4. Using a logistic regression model, the researchers determined that the odds of being in stage 3 were lower for women survivors of IPV that had low depressive and low PTSD symptoms compared with women in high depressive and high PTSD symptoms profile (OR, 0.22; 95% CI, 0.06-0.76). Lower odds of being in stage 3 were also found in women who had low PTSD and average depressive symptoms when compared with women who high depressive and PTSD symptoms (OR, 0.25; 95% CI, 0.07-0.92).

There were some limitations to this study. The study used a cross-sectional design which prevents it from establishing temporality. Criterion A trauma, associated with PTSD, was not assessed in this study. All relationships were self-reported, which could have influenced the willingness of PrEP utilization. The data may not be representative of all women who have experienced IPV. There were few women in stages 2 and 4 of the PrEP motivational cascade, which prevented them from being utilized in analysis; stage 5 of the cascade was not evaluated at all.

The researchers concluded that further studies that focus on PrEP motivation should be conducted in women, specifically in those who have survived IPV. Encouraging PrEP uptake in safe methods both psychologically and physically should be a priority in these women to encourage use of PrEP.

References

1. Phillips KA, Kernshaw T, Alexander KA, Sharpless L, Katague M, Willie TC. Examining the role of posttraumatic stress and depressive symptoms in HIV pre-exposure prophylaxis (PrEP) motivation among survivors of intimate partner violence. AIDS Behav. Published online November 25, 2024. doi:10.1007/s10461-024-04531-8
2. About intimate partner violence. CDC. 2023. Accessed November 25, 2024. https://www.cdc.gov/intimate-partner-violence/about/index.html